腹壁疝修补术后持续性心动过速预测严重不良事件的价值研究

摘要

Objective To investigate the influencing factors and clinical significance of sustained tachycardia following ventral hernia repair (VHR),and to predict the clinical value of postoperative severe adverse events.Methods From May 2014 to May 2015 in our hospital,377 cases of abdominal wall hernia repair were collected,and divided into 4 groups according to the heart rate and duration of tachycardia.Tachycardia for 8 consecutive h within one day was defined as sustained tachycardia.Severe adverse events included cardiac events,venous thromboembolism,infection,bleeding,and anastomotic leakage or intestinal leakage.The correlation between tachycardia and postoperative related serious adverse events was analyzed by Pearson χ2 test.Results There were 377 patients undergoing abdominal hernia repair.119 patients had at least one tachycardia,and 258 patients (68.4%) had no postoperative tachycardia.At least one serious adverse event occurred in 25 patients with postoperative tachycardia,and 5 patients without tachycardia.Postoperative severe adverse events occurred more likely in patients with sustained tachycardia (P<0.05).The positive predictive rate of sustained tachycardia on postoperative severe adverse events was 29.2% (95% CI:0.170-0.441),and the positive likelihood ratio was 7.6 (9.5% CI:3.4-9.7).Conclusions The incidence of tachycardia after VHR is high,and there is a great predictive value for serious adverse events after abdominal hernia repair.%目的 探讨腹壁疝修补术后持续性心动过速的影响因素和临床意义,以及预测严重术后不良事件的临床价值.方法 选取2014年5月至2015年5月在海南省人民医院行腹壁疝修补术的病人共计377例,根据心率和心动过速的持续时间将病人分为4组,术后任何一天连续8 h心动过速定义为持续性心动过速.严重的不良事件定义为:心脏事件,静脉血栓栓塞,感染,出血,吻合口漏或肠漏.各组心动过速与术后严重不良事件的相关性采用皮尔森χ2检验.结果 腹壁疝修补术病人377例,术后有119例病人至少经历了一次心动过速,258例(68.4%)病人术后无术后心动过速.术后心动过速的病人中有25例至少出现一次严重不良事件,而术后无心动过速的病人中有5例至少出现一次严重不良事件;持续性心动过速病人更易出现术后严重不良事件(P值均<0.05),持续性心动过速对术后严重不良事件的阳性预测值为29.2% (95%可信区间为0.170~0.441),阳性似然比为7.6(9.5%可信区间为3.4~9.7).结论 腹壁疝修补术后心动过速发生率较高,持续性心动过速对腹壁疝修补术后严重不良事件有较大的预测价值.